Provider Demographics
NPI:1902171770
Name:ADETOLA, ADENIYI OLABAMIJO (RN)
Entity Type:Individual
Prefix:MR
First Name:ADENIYI
Middle Name:OLABAMIJO
Last Name:ADETOLA
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 BROWN PL
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10454-4110
Mailing Address - Country:US
Mailing Address - Phone:718-401-0572
Mailing Address - Fax:718-401-0572
Practice Address - Street 1:165 BROWN PL
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10454-4110
Practice Address - Country:US
Practice Address - Phone:718-401-0572
Practice Address - Fax:718-401-0572
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-13
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY601506163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool